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Alcohol Use Disorder and Borderline Personality Disorder: The Case Study


Unhealthy patterns of alcohol use and poor impulse control when dealing with potentially addictive substances have negative influences on all aspects of life. In the case of Thomas, alcohol abuse exacerbates his pre-existing psychological issues even more. This paper discusses his case with attention to symptoms, treatment, goals, and personality disorders.

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Symptomology and Treatment Options

The description of Thomas’s social history and previous behaviors, including alcohol abuse, reveals symptoms that are indicative of alcohol use disorder (AUD) with a moderate degree of severity – 303.90 (F10.20). The man’s problematic behaviors during his last marriage point to at least four symptoms of the disorder. The first diagnostic criterion for AUD, the tendency to take more alcohol or do it for a longer period than intended, finds reflection in repetitive drinking binges lasting for several days (American Psychiatric Association, 2013). The fifth symptom of AUD is the “recurring alcohol use resulting in a failure to fulfill major role obligations” (APA, 2013, p. 491). It is manifested in Thomas’s temporary marginalization and the inability to assist his partner in housekeeping and similar activities during his periods of heavy drinking. He used to leave their home for up to five days.

Two more symptoms reveal the presence of the specified disorder. The evidence of prolonged alcohol use despite recurrent/persistent interpersonal issues exacerbated by the effects of drinking, which is the sixth criterion, can be found (APA, 2013). The patient’s wife was explicit about disliking his pernicious habits and the unwillingness to be tolerant of them, but it did not encourage Thomas to change his lifestyle. Also, the ninth diagnostic criterion, the continuation of alcohol use despite knowing that it contributes to physical/psychological issues, deserves attention (APA, 2013). Case details indicate that the patient’s periods of excessive alcohol consumption typically resulted in treatment for alcohol intoxication. Therefore, Thomas could not refrain from drinking despite knowing that he could require professional help after that.

The selection of treatment options is critical in this case. Interventions for medically-managed detoxication do not seem to be of the greatest importance since there is no evidence that Thomas had drinking binges right before a mental health evaluation. Medications that minimize alcohol’s effects or cause aversion to alcohol might be helpful if the patient reports the urge to drink or pleasure from consuming alcohol. Current meta-analytical research suggests that group-based motivational interviewing and CBT interventions are at least as effective as their individual variants for achieving abstinence from alcohol (Coriale et al., 2018). Thus, close attention should be paid to counseling and group therapy options, such as CBT sessions for groups suffering from drinking problems.

Goals and Community Resources

Aside from therapy to reduce the patient’s desire to drink, the lack of stable employment and education is the key area of concern to be addressed. At eighteen, Thomas managed to find a job to apply his creative talents, which resulted in increases in his financial independence. It is reasonable to suggest that helping Thomas to further develop his potential and competitiveness will support his determination to start a new life. Three different goals related to the selected aspect can be set to support improvement in his case.

The first goal is to enable Thomas to find hobbies that would help him to acquire beneficial social ties and become well-received in the local creative community. The resource that could be used is Contemporary Arts Center in Cincinnati that can be found at 44 E. 6th Street, Cincinnati, OH 45202. The organization offers opportunities for volunteers, and Thomas could be encouraged to write a volunteer application and collaborate with others who love art (Contemporary Arts Center, n.d.). The next goal involves encouraging Thomas to get a degree to become more competitive in the job market. The resource that would support this objective is the Art Institute of Cincinnati, located at 1171 E Kemper Road, Cincinnati, OH 45246. The institution offers a variety of programs and degrees in digital arts and graphic design. The third goal will involve helping Thomas to find a steady job after his psychological and addiction-related issues are resolved. Local employment agencies, such as Adecco Staffing with an office at 4520 Cooper Road, Suite 103, Cincinnati, OH 45242, could be helpful in achieving it.

Possible Personality Disorder

The personality disorder that Thomas may be suffering from is borderline personality disorder (BPD). It is diagnosed in individuals whose personal life and relationships are affected by instability. The second diagnostic criterion for BPD is the tendency to engage in “unstable and intense interpersonal relationships” with periods of devaluation and idealization (APA, 2013, p. 663). This description applies to Thomas’s patterns of relationships with women. Next, he displays impulsivity and the inability to refrain from high-risk behaviors related to sex (one-night stands with strangers), alcohol (drinking periods), and spending (gambling behaviors), thus meeting the fourth criterion (APA, 2013). Recurrent suicidal behaviors/threats and affective instability (irritability and temper outbursts) are also present in his case, which makes the fifth and the sixth criteria applicable (APA, 2013). The seventh diagnostic criterion, the feeling of emptiness, could also be relevant since the patient reported that issue in adolescence and probably continues suffering from it. Thus, at least five symptoms of BPD apply to the patient’s history, which makes this diagnosis an option for consideration.

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Finally, Thomas demonstrates at least four symptoms of AUD and probably has BPD, which prevents him from building long-term relationships with romantic partners and employers. After his mental condition is stabilized after attempted suicide, his life could be improved by meeting three goals related to education and employment. Diverse resources, ranging from staffing agencies to art centers, would support positive changes.


American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders, fifth edition: DSM-5. Author.

Contemporary Arts Center. (n.d.). Volunteer. Web.

Coriale, G., Fiorentino, D., de Rosa, F., Solombrino, S., Scalese, B., Ciccarelli, R., Attilia, F., Vitali, M., Musetti, A., Fiore, M., & Ceccanti, M. (2018). Treatment of alcohol use disorder from a psychological point of view. Rivista di Psichiatria, 53(3), 141-148.

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